- High-dose dexamethasone in untreated ITP patients
- Vancomycin-induced ITP
- ASH Offers new Practice Improvement Module (PIM) for ITP
- Talecris makes shipping materials “green”
- New guidelines support patient-centered ICU
- U.N. warns of potential flood of counterfeit medications
- Research funding may influence study results
- U.S. may expand access to experimental drugs
- Just believing you’re healthy brings benefits
- Inflammation plays role in heart disease in women
HIGH-DOSE DEXAMETHASONE IN UNTREATED ITP PATIENTS
Because prednisone and prednisolone are widely used first-line therapies for ITP, but long-term responses after therapy stops are very low (10%-25%), researchers in Italy tested high-dose dexamethasone (HD-DXM), another steroid, for untreated patients. In two studies, they found promising results. One study of adults showed an initial response rate of 90% and long-term response rate of 68%. A second, multicenter study in adults and children also found a high long-term response rate. They contend that their results confirm that HD-DXM can be a first-line therapy for adults and children with ITP. For both groups, 6 cycles appeared to be unnecessary. They have proposed a new randomized trial comparing 3 cycles of HD-DXM with conventional prednisone treatment for this population.
Mazzucconi MG, Fazi P, Bernasconi S, Derossi G, Leone G, Gugliotta L, Vianelli N, Avvisati G, rodeghiero F, Amendola A, Baronci C, Carbone C, Quatrin S, Fioritoni G, D’Alfonso G, Mandelli F. Therapy with high-dose dexamethsaone (HD-DXM) in previously untreated patients affected by idiopathic thrombocytopenic purpura: a GIMEMA experience. Blood, 15 Feb, 2007; 109(4):1401-07.
The antibiotic vancomycin can cause antiplatelet antibodies that lead to ITP, according to scientists at the Medical College of Wisconsin and Baylor College of Medicine. Platelet levels returned to normal in every patient after vancomycin was stopped. They suggest that testing for drug-dependent antibodies can be helpful to identify the cause of thrombocytopenia, or low platelet count, in patients receiving vancomycin.
In a Perpective in the same issue of New England Journal of Medicine, Theodore E. Warkentin of McMaster University in Ontario, Canada, describes the impact and mechanism of other drugs implicated in immune-mediated thrombocytopenia, such as quinine and heparin.
Von Drygalski A, Curtis Br, Bougie DW, McFarland JG, Ahl S, Limbu I, Baker KR, Aster H. Vancomycin-induced immune thrombocytopenia. N Engl J Med. 1 March, 2007; 356(9):904-10.
Warkentin TE. Drug-induced immune-mediated thrombocytopenia—from purpura to thrombosis. N Engl J Med. 1 March, 2007; 356(9):891-3.
ASH OFFERS NEW PRACTICE-IMPROVEMENT MODULE (PIM) FOR ITP
The American Society of Hematology is offering a new Web-based practice aid to help physicians provide the best care to patients with ITP. PIMs guide practice-based learning and improvement and include links to educational materials and other resources. Physicians who complete a PIM can earn CME credits.
TALECRIS MAKES SHIPPING MATERIALS “GREEN”
Talecris, the maker of Gamunex® an IGIV therapy that requires cold-storage shipping, has made its insulated shipping containers more environmentally friendly by using a fully degradable Control Tem Blue™ container.
NEW GUIDELINES SUPPORT PATIENT-CENTERED ICU
The American College of Critical Care Medicine (ACCM) task force issued clinical practice guidelines for support of patients and their families in adult, pediatric, or neonatal intensive care units. The guidelines define standards for incorporating families into decision making and care for ICU patients.
Critical Care Medicine, February 2007;35:605-622.
Medscape produced a CME activity around the new guidelines at: www.medscape.com/viewarticle/551738
UN WARNS OF POTENTIAL FLOOD OF COUNTERFEIT MEDICINES
Abuse of prescription drugs has surpassed elicit drug use in some places, according to the United Nations. In the U.S., prescription drug abuse is second only to marijuana abuse. The World Health Organization estimates that 10% of drugs on the global market are counterfeit. In developing countries, that number rises to 25% to 50%. The rise in counterfeit drugs is due to unregulated global markets selling through the Internet and mail order.
The Wall street Journal, March 1, 2007, pg. A4.
(Dangerous Doses, a book by Katherine Eban, is an exciting read that describes the problem. See: http://www.dangerousdoses.com/)
RESEARCH FUNDING MAY INFLUENCE STUDY RESULTS
An analysis of 111 studies of soft drinks, juice and milk published in Public Library of Science, found that studies funded entirely by the beverage industry were four to eight times more likely to be favorable to those beverages than other research. Of 22 studies funded by the beverage industry, only 14% had unfavorable findings; more than 38% of independently funded research, however, was unfavorable. The researchers would like to see more government funding for nutrition research.
Tufts University Health & Nutrition Letter, March 2007, pg. 3.
U.S. MAY EXPAND ACCESS TO EXPERIMENTAL DRUGS
The U.S. Food and Drug Administration is attempting to expand its program that enables people with life-threatening or serious illnesses to gain access to drugs that are still in testing and have not yet been approved by the FDA. For decades the FDA has allowed certain patients with AIDS and cancer to access experimental therapies on the grounds of “compassionate use” after all other avenues have been explored. The new rules spell out a broadening of who is eligible for unapproved drugs, how to request them, and how much companies can charge for them. Opponents of the expansion say that expanded access to these drugs will harm clinical trial enrollment, and may provide access to drugs that have not been well enough tested in humans and may cause more harm than good.
The comment period on the proposed rules was set to close in March. http://www.fda.gov/cder/regulatory/applications/IND_PR.ht
Nature Medicine February 2007, 13(2):111.
JUST BELIEVING YOU’RE HEALTHY BRINGS BENEFITS
The mere belief that you are getting a workout may provide similar benefits to actual exercise. Researchers at Harvard University enrolled two groups of hotel housekeepers in the study. One group was told that their regular work was good exercise and met the guidelines for a healthy, active lifestyle. The other group was told nothing. Although the amount of activity done by the women did not change during the 4 weeks of the study, the “informed” group commented that their lives were healthier, and they lost an average of 2 pounds, their blood pressure dropped, and they lost body fat. The women who were told nothing experienced no changes.
The Wall Street Journal, February 2, 2007, pg. B1.
INFLAMMATION PLAYS ROLE IN HEART DISEASE IN WOMEN
Heart disease is not gender-neutral, according to new research from Cedars-Sinai Medical Center in Los Angeles. Many women have a form of heart disease called coronary microvascular dysfunction that isn’t detected by standard diagnostic procedures, according to the NIH-funded Women’s Ischemia Syndrome Evaluation (WISE) study. This means that, instead of plaque causing obstructions in a large coronary artery, women are more likely to experience narrowing of the tiny vessels of the heart. This may help explain why so few women have the crushing chest pain that men experience. More often, they feel less dramatic symptoms, such as diffuse discomfort, exhaustion, or shortness of breath. The researchers found high levels of certain inflammatory substances in women at higher risk for heart disease. The inflammatory substances course through the blood stream, stripping away cells that line the blood vessels, allowing cholesterol to form plaques and stiffen the vessel walls. Inflammation persists as the vessels try to repair themselves and risk for clots increases. Bottom line: Risk is higher for African American women and premenopausal women with inflammatory disorders, autoimmune diseases, or low estrogen levels. Live heart-healthfully by getting regular exercise, maintaining a healthy weight, not smoking, and controlling levels of cholesterol, glucose, and blood pressure. See a doctor if you experience unexplained fatigue or shortness of breath.
Harvard Women’s Health Watch, February 2007, pg. 1.